The President’s Council on Bioethics
1801 Pennsylvania Avenue, N.W., Suite 700
Washington, D.C. 20006
September 28, 2005
The President
The White House
Washington, D.C.
Dear Mr. President:
I am pleased to present to you Taking Care: Ethical Caregiving
in Our Aging Society, a report of the President’s Council
on Bioethics. It seeks to gain attention for a burgeoning social
problem and to offer ethical guidance regarding the care of our
elders who can no longer care for themselves.
American society is aging—dramatically, rapidly, and largely
well. More and more people are living healthily into their seventies
and eighties, many well into their nineties. With birth rates
down, with the baby boomers approaching retirement, we are on
the threshold of the first-ever “mass geriatric society.”
The fastest growing segment of our population is already the group
over 85. Historically speaking, it is the best of times to be
old.
Yet the blessings of greater longevity are bringing new social
challenges. Although people are living healthier longer, many
are also living long enough to suffer serious age-related chronic
illnesses, including dementia. Alzheimer’s disease now afflicts
more than four million Americans, and the number is expected to
triple before mid-century. Already by far the most common trajectory
toward death is a lengthy period of debility, frailty, and dementia
lasting not months but years. Already millions of American families
are struggling nobly to provide steady and demanding long-term
care for their incapacitated loved ones, often with little respite
or communal support, usually for many years. Yet precisely as
the need for caregiving rises greatly, the number of available
caregivers—both professional and volunteer—is dwindling.
We appear to be on the threshold of a crisis in long-term care.
As a society, we have not yet faced up to this difficulty, especially
in its human dimensions. And the popular legal instruments that
we are being encouraged to employ to avoid the problem will fall
short of what we need as individuals. As this report points out
in great detail, living wills, drafted years in advance, are not
the answer. They simply cannot substitute for reliable and responsible
caregivers on the spot, devoted to the welfare of the incapacitated
person here and now. Even worse is the deadly “solution”
of legalizing assisted suicide and euthanasia, advocates for which
are again active in several state legislatures. Caring wholeheartedly
for a frail patient or a disabled loved one is incompatible with
thinking that engineering their death is an acceptable “therapeutic
option.” Betrayal and abandonment of the elderly can never
be part of a decent and compassionate society, one devoted to
the equal worth and dignity of every human life, from start to
finish, regardless of personal strengths, weaknesses, or disabilities.
In addition to calling attention to the larger social issues of
long-term care, this report therefore also tries to articulate
the goals and principles of ethical caregiving for persons no
longer able to care for themselves. We emphasize both the singular
importance of seeking to serve the life the patient still has
and the moral necessity of never seeking a person’s death
as a means of relieving his suffering. At the same time, we emphasize
also that serving the life the patient still has does not oblige
us always to elect life-sustaining treatments, when those interventions
impose undue additional burdens on that life or interfere with
the comfortable death of a person irretrievably dying. Even when
the doctor’s black bag of remedies is empty, comfort and
care remain inviolable duties.
If our elderly are to be well cared for and if family caregivers
are to be able to care well, caregiving needs to be supported
by our civic and faith-based communities but also with the help
and encouragement of government. Yet as we bend our efforts in
support of the elderly, we can ill afford to neglect the needs
of the young, who, unlike the old, have no organized voice to
speak up for their needs. We must at all costs avoid a conflict
between the generations over scarce resources.
To help us think through these very complex issues, we need sustained
research, hard thinking, and a creative search for modest reforms
that could make a big difference. And we need leadership at the
highest level. Therefore, among our recommendations, we call for
a Presidential Commission on Aging, Dementia, and Long-Term Care,
to focus the nation’s attention and to carry forward this
work. Any approach our society takes must attend to the ethical
and humanistic dimensions of our situation, not only the economic
and institutional ones. For we will be judged as a people by our
willingness to stand by one another, even as the flame of life
flickers and fades in those who have brought us here and to whom
we owe so much.
Mr. President, allow me once again to thank you, on behalf of
my Council colleagues and our fine staff, for this opportunity
to offer you and the American people our assistance in promoting
a future in which human well-being will be served by science and
medicine, human beings will be respected at every stage of life,
and human dignity will always be upheld and preserved.
Sincerely,
Leon R. Kass, M.D.
Chairman